Cemental Tear in an Autotransplanted Tooth That Had Been Functioning for 15 Years

Autotransplantation of the Third Molar: A Therapeutic Alternative to the Rehabilitation of a Missing Tooth: A Scoping Review

INTRODUCTION

Tooth autotransplantation is the repositioning of an erupted, partially erupted, or non-erupted autologous tooth from one site to another within the same individual. Several factors influence the success rate of the autotransplant, such as the stage of root development, the morphology of the tooth, the surgical procedure selected, the extraoral time, the shape of the recipient socket, the vascularity of the recipient bed, and the vitality of the cells of the periodontal ligament. The aim of this scoping review was to provide the most up-to-date information and data on the clinical principles of the third-molar autograft and thus provide clinical considerations for its success.

MATERIALS AND METHODS

This review was conducted based on PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). The research was conducted by searching for keywords in three databases-PubMed, Scopus and Google Scholar-by two independent reviewers following the PRISMA protocol, from which 599 records were identified.

CONCLUSIONS

Third-molar autotransplantation is a valid solution to replace missing teeth. The key to the success of this technique is the surgical procedure, which must be as atraumatic as possible to preserve the periodontal ligament of the tooth to be transplanted. The success rate is also linked to the stage of development of the root, with a worse prognosis in the case of a complete root.

Cemental tear: Literature review, proposed classification and recommendations for treatment

Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.

Clinical and Histologic Aspects of Cervical Cemental Tear as a Risk for Periodontal Diseases

INTRODUCTION

Cemental tear (CeT) has been classified as a specific type of root fracture. It can lead to rapid periodontal breakdown, and recently not many reports have focused on periodontal concerns. This case report presents macroscopy, light microscopy (LM), and scanning electron microscopy (SEM) observations of fragments of CeT. Progression of periodontal disease is discussed in terms of anatomic characteristics of the cementum.

CASE PRESENTATION

CeT was observed at a maxillary right central incisor of an 83-year-old male. After clinical examination and initial treatment, surgical periodontal therapy was performed in association with fragment extirpation, apicoectomy, replantation, and simultaneous regenerative treatment. Extirpated torn fragments and granulation tissue masses were subsequently examined by LM and SEM. Bacterial colonies were observed in and around peripheral crevices of cemental fragments.

CONCLUSIONS

Characteristics of cervical CeT are similar to common periodontitis features, such as rapid, periodic, sporadic, and site-specific advance, with occasional spiral pattern of pathologic pockets. In this case report, these features correspond to progression of bacterial pollution along the periphery of the overlapping scales of the cementum. In cases with such advanced periodontitis features, CeT should be discussed as a possible diagnosis. Optimum treatment should be more interventional, such as removal of degraded and torn cemental layers, when definite diagnosis is made by intrasurgical inspection.